<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket="http://wicket.apache.org">
<wicket:panel>
    <form wicket:id="locatieForm" class="not-tracked-for-changes-on-page">
        <div class="modal-header">
            <button type="button" class="close" data-dismiss="modal">&times;</button>
            <h3>Tehuis adres</h3>
        </div>
        <div class="modal-body">
            <div class="form-horizontal">
                <div class="control-group">
                    <label class="control-label">Postcode</label>
                    <div class="controls">
                        <input wicket:id="postcode" class="input-mini" type="text"
                               value="">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Huisnummer</label>
                    <div class="controls">
                        <input wicket:id="huisnummer"
                               class="input-small" type="text" value="">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Huisnummertoevoeging / Huisletter</label>
                    <div class="controls">
                        <input wicket:id="huisnummerToevoeging"
                               class="input-small" type="text" value="">
                        / <input wicket:id="huisletter" class="input-small"
                                 type="text" value="">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label">Locatie van tehuis? *</label>
                    <div class="controls">
                        <input type="checkbox" wicket:id="locatieVanTehuis"/>
                    </div>
                </div>
            </div>
        </div>
        <div class="modal-footer">
            <button class="btn btn-primary right" wicket:id="opslaan">Opslaan</button>
            <p class="floatleft">* = Indien uitgevinkt wordt bij een verhuizing van de laatste gekoppelde cliënt het adres ontkoppeld van dit tehuis.</p>
        </div>
    </form>
</wicket:panel>
</html>
